老年人胃癌、结直肠癌和肺癌的分期、治疗和死亡率模式：有无预先存在痴呆的日本多中心队列研究。
Patterns of staging, treatment, and mortality in gastric, colorectal, and lung cancer among older adults with and without preexisting dementia: a Japanese multicentre cohort study.
机构信息
Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, 541-8567, Osaka, Japan.
出版信息
BMC Cancer. 2023 Jan 19;23(1):67. doi: 10.1186/s12885-022-10411-y.
BACKGROUND
Little is known about dementia's impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia.
METHODS
Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65-99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014-2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival.
RESULTS
Among gastric (n = 6016), colorectal (n = 7257), and lung (n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer.
CONCLUSION
Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
背景
关于痴呆症对癌症患者的诊断、治疗和结局模式的影响知之甚少。本研究旨在阐明患有和不患有预先存在痴呆症的老年癌症患者在癌症分期、治疗和死亡率方面的差异。
方法
本多中心回顾性队列研究使用来自日本 30 家医院的癌症登记数据和行政数据，纳入了 2014 年至 2015 年新诊断为胃癌、结直肠癌或肺癌且年龄在 65-99 岁的患者。行政数据中的临床记录中提取痴呆症状况（无、轻度和中重度）作为感兴趣的暴露因素。我们构建了多变量逻辑回归模型来分析癌症分期和治疗，以及多变量 Cox 回归模型来分析三年生存率。
结果
在胃癌（n=6016）、结直肠癌（n=7257）和肺癌（n=4502）患者中，分别有 5.1%、5.8%和 6.4%患有痴呆症。患有痴呆症的患者更有可能被诊断为未分期和晚期癌症；不太可能接受 I 期、II 期和 III 期胃癌以及 I 期和 II 期肺癌的肿瘤切除术；不太可能接受 III 期和 IV 期肺癌的药物治疗；更有可能接受所有分期结直肠癌的肿瘤切除术；并且更有可能在癌症诊断后三年内死亡。中重度痴呆症的影响大于轻度痴呆症，除了结直肠癌的肿瘤切除术。
结论
患有预先存在痴呆症的老年癌症患者接受标准癌症治疗的可能性较低，并且更有可能出现较差的结局。临床医生应该意识到这些风险，并受益于标准化指南，以帮助他们在诊断和治疗这些患者时做出决策。
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